Experience 3: New digital medical coordination between organizations

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One of the first world’s most difficult medical problems is coordinating care between different providers and medical institutions. In 2025 new levels of fast and effective medical coordination will have become normal.

Today’s medical coordination has been described as “poor” between primary care physicians, specialists and other organizations. These problems reduce quality of care, patient outcomes and provider satisfaction — while raising costs.

A Digital Earth’s medical coordination will expand to include first responders like the military, homeland security and 911 emergency services. The Centers for Health Expansion (CHE) relies on this to handle the unexpected medical crisis of a new, vaccine-resistant strain of Ebola.

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While Dr. Chester guided Dr. Mayhew and Nurse Sweeney in the Ebola diagnosis of Kani Imara, Ms. Leck took advantage of the CHE’s First Response Shared Space. She scanned its Active Knowledge protocol for next steps. That led her to Activate Jeff Dermody, a CHE State and Local Response specialist who could arrange the delivery of HazMat suits to the clinic, transport of this infectious patient to a hospital, and hospital treatment for the patient.

Dermody smiled grimly when he heard the situation. “Sorry to hear about this, but that’s why we’re ready.”

Dermody saw Tom Figuera was Active in the Shared Space. As a CHE Personal Protective Equipment specialist, he asked Tom to take care of the HazMat suits. Dermody told Ms. Leck he would arrange patient transport and admission to the best nearby hospital with an isolation unit.

Tom muted his connection with the rest of the Shared Space, then Focused the CHE’s Strategic Supplies Shared Space where HazMat suits are managed. He followed its Active Knowledge protocol. The CHE kept small numbers of “HazMat Packs” pre-positioned in major cities with a larger supply at its central repository. Tom Activated Nadia Mahdi, the CHE’s Central U.S. Emergency Manager responsible for the closest HazMat repository to Madison, which was in Milwaukee.

“There’s 10 HazMat Packs available in Milwaukee,” Nadia said, displaying Milwaukee’s HazMat inventory from her office in Ann Arbor, Michigan. Each “Pack” included a HazMat suit with extra gloves, booties and hoods. It also included tape, a HEPA filtered breathing/cooling unit, personal communicator, enough disinfectants for six cleanings, and disposal supplies. They decided to deliver all ten HazMat Packs to the Madison clinic, with half used for patient transport and half kept in Madison by the delivery service, in case any anyone else had contracted Ebola from the patient.

Active Knowledge protocols provide next steps guidance, so best practices are learned, improved and applied when needed.

Nadia Activated their local delivery service’s representative in Milwaukee. Teri Kelly was on duty and displayed their warehouse’s video views live on their screens.

“We definitely have the 10 HazMat Packs on aisle 14, bin 37,” she said, zooming in on them. “We’ll have them at the Madison clinic in less than 2 hours.”

“This is a critical delivery,” Nadia said. “I’m going to stay Active with your people in their Shared Space while they retrieve the HazMat Packs and deliver them.”

Tom saw that was under control, so he muted Nadia’s Shared Space with the delivery service. He unmuted his connection to the examination room in Madison, in case he was needed by the garbed medical staff that was wearing PPE.

Meanwhile, Dermody had Activated Adam Casey, the supervisor of the Madison ambulance service that would provide patient transport. He also Activated Dr. Oscar Bothwick, CEO of Chicago’s Rush University Medical Center, the nearest hospital with a secure infectious disease isolation unit.

After introducing himself he told them. “We have an Ebola patient in Madison who needs to be transported to Chicago and treated in your hospital’s isolation unit. Ebola is an infectious disease from Africa with about a 60% mortality rate. We think this is a new strain of Ebola that’s resistant to the Ebola vaccine, so this requires full HazMat suits.”

So they could assess the situation he switched their screen’s background to the Madison clinic‘s examination room.  Harvard’s Dr. Chester was guiding Dr. Mayhew and Nurse Sweeney, who were wearing Personal Protective Equipment, in diagnosing Kani Imara for Ebola.

Dr. Chester immediately confirmed the Ebola diagnosis and Dermody made a brief video of the patient’s condition to inform the ambulance and hospital staffs.

Tom Figuera and Li Min helped them plan the patient transport. Tom told them the HazMat Packs would be at the clinic in 2 hours. Five HazMat suits would be available for the transport team.

“I’ll help the ambulance paramedics put on the HazMat suits,” Tom said, “then remain with them during the 3 hour drive to Chicago, and help them remove the HazMat suits safely and clean up.”

Some Shared Spaces and specialists can focus on coordination, to make sure multiple organizations, people and resources are coordinated well.

Li Min, the CHE’s Infection Control specialist, said she would guide the preparation of the ambulance for the trip, then guide its disinfecting afterward. While they were on the way to Chicago, she would help sterilize the Madison student health center.

Dr. Chester added that he would give the paramedics instructions on how to care for the patient while being transported, and remain accessible if they had a question while en route.

The CHE’s Communication specialist, Lisa Garber, asked to stay with Dermody, the ambulance service supervisor and the hospital administrator. 

Dermody thanked those at the Madison clinic. He muted them and replaced Lisa, Casey and Bothwick’s screens’ background with a road map of the region, showing the route from Madison to Chicago. The map displayed the travel time and estimated patient arrival time at the Chicago hospital.

Bothwick, the hospital Administrator, had watched everything quietly, occasionally nodding his head.

“I assume the hospital will be ready,” Dermody said to him.

“Definitely. Our infectious disease isolation unit has a trained staff of 10 doctors and 20 intensive care nurses,” Bothwick said. “They’re prepared for anything whether it’s a bio-terror attack or a deadly pandemic. They’ll be ready when this patient arrives.”

“Then he’s yours,” Dermody said.

“Then let’s get it started, “ Dr. Bothwick replied, Focusing the hospital’s Emergency Response Shared Space and adding them to it. He set the Shared Space’s background to a live view of one of the isolation unit’s available rooms. Then he selected all the hospital’s department heads and Activated them all at once. The Presence System located the ones currently Present, or each of their immediately available substitutes. In seconds they were all turning to their screen, tablet or smart phone. They all saw everyone who had been alerted, with the hospital’s isolation room on screen, as their background.

Large numbers of people in multiple Shared Spaces can be focused all at once, to tell them all how to deal with a serious situation or problem.

“Sorry to interrupt,” the Administrator said.  “A new strain of Ebola is in the U.S. The first case has just been diagnosed in Madison and the patient will arrive here, at Rush, in about 5 hours. So you know what’s coming, here’s a short video from his examination in the University of Wisconsin’s Student Health Center.”

While the video played he said, “You can share this video from this Shared Space. I’ll add the patient’s medical report as soon as it arrives from Harvard’s Dr. Richard Chester, who supervised the diagnosis.

He continued after the video, “For now, we’ll use this Shared Space for coordination and I’ll remain Active in it, ready to help. Focus each of your own group’s Shared Spaces and get your team’s people, supplies and processes ready. Ebola is lethal so this is a full HazMat case because our doctors and nurses face the biggest risk. I’ll help handle cross departmental issues and any approvals needed will come through these people from the CHE. They’ll stay here as well, so keep us updated on your progress.”

He enlarged Lisa Garber’s image. “I’d like to introduce you to Lisa Garber, a communications specialist from the CHE.”

Lisa zoomed her image to full screen and said, “The word is about to get out that Ebola is in the United States. As the hospital on the front line, you will receive constant questions from the media, other hospital patients, the community, even your families. I’m here to help you handle this. Now, we should have a daily press conference, with the first one about 2 or 3 hours after this patient arrives.”

Dr. Bothwick turned the screen back to a group and asked, “Dr. Weinberg, as the head of the isolation unit, do you think you could participate in a joint press conference with the CHE later today?” Dr. Bothwick asked.

“If you think I’m the right person, of course,” Weinberg said.

“You’re perfect,” Lisa said. “The CHE will report a single person has been diagnosed with Ebola, has been isolated and is in treatment,” Lisa said. “You’ll provide the patient details but will keep that shallow because of patient confidentiality.”

“Uh, how big will the press conference be?” Dr. Weinberg asked.

In a high-interest event that has major media attention, Shared Spaces are ideal for preparing for the media, as well as delivering to a high-growth global audience.

“The CHE will use its Media Shared Space to send out an alert. There will probably be thousands of journalists who attend online from all over the world. Rush will be worldwide by this evening, and you’ll be the face of Rush’s medical staff.”

“Let me give you perspective,” Dermody said. “The CHE has known about this for less than an hour, so we’re figuring this out by responding to it. But we’re the nation’s medical firewall and you’ve just become the medical front line that’s keeping this country safe. If you need anything, and I mean anything, don’t hesitate for one second to let anyone at the CHE know. We’re all connected in Shared Spaces and every one of us is dedicated to helping you succeed. We may not look like warriors, but we’re good ones and we’re in this fight with you.”

While the patient was transported, the CHE Focused and alerted participants in a number of related Shared Spaces. These included infectious disease physicians and nurses, public health agencies, pharmaceutical companies, medical equipment vendors, medical labs and researchers. By the time the Ebola patient arrived at the hospital, thousands of professionals were live and working together in a range of Shared Spaces, self-organizing and ready to observe and assist the hospital, as well as learn from each other. With every passing minute they advanced their abilities to analyze this new Ebola strain’s DNA, determine its virulence and treatment, adapt the previous working vaccine, turn their findings into Active Knowledge protocols, and prepare their own organizations’ Shared Spaces. Each participated in expanding the nation’s abilities to fight this dangerous disease.

Within hours the U.S.A. was rapidly mobilizing to defeat this new, resistant strain of Ebola. As the word spread through medical shared spaces it dovetailed with the CHE’s press announcement which was immediately picked up by both the news and social media. By the time the CHE’s press conference began that evening almost a million reporters, bloggers, tweeters, health care specialists and alarmed people were viewing it from around the world. They started by joining the CHE’s Communications Shared Space, then added the live press conference to their other Focused and Active Shared Spaces so they could discuss it with others while it happened. Every recipient, in turn, could add the press conference to their other Focused Shared Spaces.

Shared Spaces can rapidly add people and resources, and grow quickly. They can also spawn new Shared Spaces and grow into one or more networks of related Shared Spaces.

By the time the CHE’s Lisa Garber opened the press conference, the audience was growing by hundreds more Shared Spaces every minute. By the time the press conference ended any sense of panic had dissipated, replaced by the confident feeling that digital medicine brought together experts that could handle anything.

In a live event attended through Shared Spaces, the audience can add others to their Shared Spaces. Those people, in turn, can add the event to other Shared Spaces.The event can spread quickly through networks of related Shared Spaces, growing quickly to large numbers worldwide.

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